Effectiveness of local anaesthesia (clonidine and fentanyl) infiltration for post-submucosal resection pain relief: a randomized, double-blinded clinical trial.

BACKGROUND: Submucosal resection is accompanied by significant post-operative pain and discomfort. The aim of this randomized, double-blinded clinical trial was to study the efficacy of a local block anaesthetic, delivered after induction of general anaesthesia, in reducing post-operative pain. METHODS: Patients aged 16 years and over who were scheduled for elective submucosal resection were randomly assigned to receive either standardized general anaesthesia, general anaesthesia with local anaesthetic infiltration or general anaesthesia with placebo infiltration. Haemodynamic stability, intra-operative blood loss, post-operative pain (over a seven day follow-up period), analgesics consumption, hospital stay, and the patient's and surgeon's levels of satisfaction were assessed. RESULTS: We found significantly lower results for pack removal pain score, volume of intra-operative blood loss, number of patients suffering from headache, altered dental sensation or nasal pain, number of patients who consumed analgesics, and length of hospital stay, comparing the infiltration group with the general anaesthesia and placebo groups (p<0.05). CONCLUSION: This clinical trial showed that infiltration with the local anaesthetics fentanyl and clonidine substantially reduced post-operative pain and shortened patients' hospital stay.

Estrogenic activity in women receiving an injectable progestogen for contraception.

PIP: 121 multiparous women (aged 15-37) who had received injections of 150 mg of depomedroxyprogesterone acetate (DMPA) every 3 months as a contraceptive for more than 1 year, were examined to assess possible clinical alterations due to low estrogen levels. Serum samples were taken to evaluate estradiol levels by radioimmunoassay. Clinical examination did not reveal any sign of estrogen deficiency, except a smaller uterine than expected. Serum estradiol concentrations (36-42 pg/ml) were in the range of the follicular phase estradiol levels of the normal ovulating woman. As this follicular level probably persists throughout treatment, total estrogenic stimulation of end organs was much lower than for cycling women, but greater than for post-menapausal women. Patients receiving DPMA have functioning ovaries which continue to secrete estradiol at follicular levels. Uterine atrophy and shift in maturation index during contraceptive treatment with this drug is due to the large dose of progestogen outweighing the low levels of estradiol. It is suggested that long-term studies are needed to determine the possible advantage of increasing the estrogen effect on end organs over the known adverse effects of estrogen administration.^ieng

Cross-reaction of contraceptive steroids in competitive binding assays of progesterone and estradiol.

PIP: Cross-reaction of oral contraceptives (OCs) in competitive binding assays of progesterone and estradiol was investigated. The compounds tested were chlormadinone acetate, diethylstilbestrol, dimethisterone, dydrogesterone, ethinyl estradiol, ethynodiol diacetate, megestrol acetate, mestranol, norethynodrel, norethindrone, d-norgestrel, medroxyprogesterone acetate, quinestrol, and quingestanol acetate. Only ethinyl estradiol had a cross-reaction of more than 1% (2%) in the estradiol radioimmunoassay and dydrogesterone (1.4%) and d-norgestrel (4%) were the only compounds that showed a cross-reaction more than 1% in the progesterone competitive protein-binding assay. These results indicate that the steroids tested, in doses currently being used in OCs, will not markedly interfere with the assay of endogenous estradiol and progesterone.^ieng

Serum gonadotropin and steroid patterns during the normal menstrual cycle.

PIP: At the University of Southern California School of Medicine, the reproductive hormones follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and estradiol were measured in serum samples obtained daily from a group of women throughout a normal menstrual cycle. Competitive binding techniques were used for the analysis of aliquots from the 10 women, aged 20-28, whose hormonal levels were studied. The results were generally in agreement with those of previous investigators, whose separate researches were less extensive than the research described here. FSH showed an early follicular phase rise, a late follicular phase decline, and a midcycle peak occurring on the day of the LH peak or on the day before and followed by a luteal phase decline. LH showed a slight progressive rise in the follicular phase, a midcycle peak, and a slight fall in the luteal phase. Estradiol also reached a midcycle peak. After the midcycle peaks, a rise progesterone. Progesterone and estradiol fell a few days before menstruation.^ieng